tailieunhanh - CURRENT ESSENTIALS OF CRITICAL CARE - PART 9

Chảy máu từ một hoặc nhiều các trang web, với vết thâm tím, chảy máu cam, chảy máu nướu, tiểu máu, hematochezia, nôn ra máu, rong kinh kéo dài PT, PTT bình thường hoặc kéo dài, thời gian bình thường thrombin | 244 Current Essentials of Critical Care Warfarin Poisoning Essentials of Diagnosis Bleeding from single or multiple sites with bruising epistaxis gingival bleeding hematuria hematochezia hematemesis menorrhagia Prolonged PT normal or prolonged PTT normal thrombin time normal fibrinogen level Can occur either by ingestion of warfarin drug or ingestion of rodenticides containing similar agents most rodenticides contain small amounts of anticoagulant and rarely associated with significant toxicity Allopurinol cephalosporin cimetidine tricyclic antidepressant erythromycin NSAIDs ethanol increase anticoagulant actions of warfarin and contribute to toxicity Differential Diagnosis Other causes of coagulopathy including liver disease vitamin K deficiency disseminated intravascular coagulation sepsis-related coagulopathy Treatment Gastric decontamination within 1 hour of ingestion For life-threatening bleeding immediate reversal with fresh frozen plasma IV vitamin K For non-life-threatening bleeding oral or IV vitamin K in patients not requiring long-term anticoagulation For non-life threatening bleeding in patients requiring subsequent long-term anticoagulation partial correction with fresh frozen plasma For prolonged PT without bleeding observation alone usually sufficient Pearl Warfarin can be associated with several skin abnormalities including urticaria purple toe syndrome and skin necrosis. Reference Ansell J et al Managing oral anticoagulant therapy. Chest 2001 119 1 Suppl 22S. PMID 11157641 -----17---------- Environmental Injuries Carbon Monoxide CO Poisoning. 247 Electrical Shock Lightning Injury. 248 Frostbite. 249 Heat Stroke. 250 Hypothermia. 251 Mushroom Poisoning. 252 Near Drowning. 253 Radiation Injury. 254 Snakebite. 255 Spider Scorpion Bites. 256 245 This page intentionally left .